Summary3 min read

Podcast Summary: Dr. Chapa’s OBGYN Clinical Pearls

Episode: 5mm v 1-cm Fascial Closure at CS: MINI EPISODE
Date: June 6, 2026
Host: Dr. Chapa
Theme: Evidence-based recommendations for fascial closure techniques during Cesarean sections

Episode Overview

This quick, focused episode addresses a critical technical decision in Cesarean (C-section) surgeries: Should clinicians use 5mm or 1cm bites when closing fascial incisions? Dr. Chapa distills the latest evidence, comparing traditional teachings with up-to-date clinical data, providing immediately applicable pearls for medical students, residents, and practicing clinicians.

Key Discussion Points & Clinical Insights

1. Historical Teaching vs. Emerging Evidence

Traditional Approach:
- For years, surgical training emphasized the use of 1cm bites—roughly “the size of a fingertip”—between suture throws during fascial closure at C-section, particularly for low transverse (“Pfannenstiel”) incisions.
- This technique was considered adequate for effective binding, given the anatomical and tensile properties of the fascia.
New Evidence (May 2026, Hernia Journal):
- Key Insight: Recent comparative studies found that 5mm suture bites are superior to 1cm bites for fascial closure.
- Benefits of 5mm Bites:
  - Less tension distributed across the fascia
  - Significantly reduced risk of hernia formation in both the short and long term
  - Superior healing outcomes
Applicability:
- Most of this research focuses on vertical fascial incisions but the physiological principles extend to horizontal incisions (e.g., Pfannenstiel).
- Even though “skin is one thing, that’s something else,” Dr. Chapa emphasizes that these findings specifically pertain to fascial closure.

“It is actually true and more evidence-based to do 5 millimeter suture bites, whether it’s a vertical fascial incision or a horizontal fascial incision like on a Pfannenstiel, because it decreases tensional forces, it increases better healing, and decreases hernia formation.”
— Dr. Chapa [02:04]

2. Anatomy & Tension Distribution

Fascial Closure Basics:
- The fascia (“from Latin—it means to bind or to hold together”) is the critical connective tissue layer of the abdominal wall.
- Proper closure technique optimizes tension distribution and supports robust healing post-CS.
Horizontal vs. Vertical Closure:
- While horizontal (Pfannenstiel) incisions align with “Langer’s lines of tension,” the core advantage of smaller bites holds true across different incision orientations.

3. Practice Patterns Among OBGYNs

Dutch Study (2021, Hernia Journal):
- Surveyed practicing OBGYNs on their fascial closure techniques, especially for Pfannenstiel incisions.
- Results: “It’s pretty much 50/50. 50% use 5 millimeter bites and the other 50% use 1 centimeter bites.”
- Consensus: Literature from both OBGYN and general surgery points to the superiority of 5mm bites even in horizontal (Pfannenstiel) incisions.

“They concluded that in accordance with the best literature in general surgery, it seems that even on a Pfannenstiel, 5 millimeter bites fascial closure is the better way to go.”
— Dr. Chapa [03:00]

Notable Quotes & Memorable Moments

On Shifting Practice:

“Even though we all were taught that 1cm bites were okay on the fascia, it is actually true and more evidence-based to do 5 millimeter suture bites...”
— Dr. Chapa [02:28]
Practical Summary:

“Whether it is a vertical fascial incision or low transverse Pfannenstiel, 5 millimeter bites seem to be the best way to go for better fascial healing.”
— Dr. Chapa [03:30]
On Purpose:

“We’re just trying to fulfill our life calling and our mission. This is Dr. Chapa’s OBGYN no Spin Podcast.”
— Dr. Chapa [00:34, 03:45]

Important Timestamps

[00:34] — Introduction and background on fascia and C-section incision techniques
[01:20] — Summary of new research (May 2026, Hernia Journal) supporting 5mm over 1cm bites
[02:28] — Discussion of how evidence challenges traditional instruction
[03:00] — Reference to the 2021 Dutch OBGYN study and shifting standard of care
[03:30] — Final evidence-backed clinical recommendation: use 5mm bites for all fascial closures

Key Takeaway

Bottom Line:
Emerging evidence strongly supports using 5mm suture bites—rather than 1cm—for fascial closure at Cesarean section, regardless of incision orientation. This technique optimizes healing and reduces the risk of postoperative hernias.

Stay tuned for more quick, evidence-based Clinical Pearls from Dr. Chapa!

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Transcript3 lines

[00:01]
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[00:03]
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[00:35]
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We're just trying to fulfill our life calling and our mission. This is Dr. Chapa's OBGYN no Spin Podcast. Hey everybody, welcome to a targeted, very fast episode on how we should best close the fascia at C section. Remember that the word fascia comes from Latin. It means to bind we or to hold together the aponeurosis of the abdominal muscles of the abdominal wall form the fascia. Now, historically we were taught that doing 1cm bites in between suture throws, in other words, about the size of a fingertip in between each bite was okay as long as you went fan and steel. In other words, low transverse in the abdominal wall. But is that really the best? There has been data as recent as May of 2026 in the journal Hernia that looked at the best way to close the fascia. Now, even though the majority of that data was on vertical fascial incisions up and down on the abdomen, it did find that 5 millimeter bites was superior to 1 centimeter bites in terms of fascial closure. Less tension on the fascia and it reduced hernia formation not just in the short term, but in the long term as well. Now, it is true there's different dynamics in a vertical skin incision and fascia versus a horizontal fascial incision. Remember, the skin is one thing, that's something else. But we're talking about fascial closure here. Even though a horizontal fascial incision goes with Langer's lines of tension, it is true that 5 millimeter bites is actually superior to the 1 centimeter bites we were originally taught, including myself, because it reduces the already low risk of hernia formation even more and equally distributes tension along that suture line. So even though we all were taught that 1cm bites were okay on the fascia, it is actually true and more evidence based to do 5 millimeter suture bites, whether it's a vertical fascial incision or a horizontal fascial incision like on a band steel, because it decreases tensional forces, it increases better healing and decreases hernia formation. There was a recent publication in 2021 also in the journal Hernia out of the Dutch that looked at OBGYN physicians in that cohort and found it's pretty much 50 50. 50% use 5 millimeter bites and the other 50% use 1 centimeter bites on fattened skin incisions. But they concluded that in accordance with the best literature in general surgery, it seems that even on a fan and steel 5 millimeter bites, fascial closure is the better way to go. So that's our quick episode. How to close the fascia. Whether it is a vertical fascial incision or low transverse band, steel 5 millimeter bites seems to be the best way to go for better fascial healing. That's it. We'll see you on another episode of the no Spin Podcast. We're just trying to fulfill our life calling and our mission. This is Dr. Choppa's OBGYN no Spin Podcast.